My son Aaron used a Passy-muir valve with subglottic stenosis and did fine with it. Aaron's airway was approximately 75% occluded (grade 2 stenosis). It did take him some time to adjust to the valve. Eventually, once he got used to talking, he didn't want anything on the trach and he would use his chin to cover the tube in order to speak.
Cindy - Mom to Aaron (age 19), trached for 4 years, subglottic stenosis, ADHD, learning disability, former 26 week preemie and identical twin to Eric (age 19), spastic quad CP, moderate MR, seizure disorder; Anthony (age 19), spastic quad CP, g-tube, seizure disorder, cortical vision impairment, profound MR; and Natasha (age 6) CP, cortical blindness, seizure disorder, profound MR, shunt, g-tube.
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